Access to eye health services among older people with disabilities in Karamoja, Uganda: a qualitative exploration of successful care seeking.

Background: Older people with disabilities frequently have high healthcare needs, but little is known about how they access health services or effective strategies to improve their access. The aim of this study was to explore journeys to access eye health services of older people with diverse disabilities in two districts in Karamoja, Uganda, and to identify the resources they drew on to access care. This study provides evidence about how older people with diverse disabilities in Uganda access eye health services and provides insights into how access can be expanded across this group.

Methods: We used a positive deviance approach focussed on successful care seekers to identify strategies that may help improve access among this group. We purposively selected 20 older men and women with different disabilities from two districts of Karamoja, who had successfully accessed eye care services. We generated data through in-depth interviews and analysed it using Levesque's conceptual framework of access to health care to situate and describe the findings.

Results: Participants narrated their eye health seeking journeys and described a wide range of factors that supported and hindered them across different domains described in the Levesque framework. For example, people's ability to perceive their eye healthcare need could be hindered by the similarity of symptoms with their existing disability, or by understanding them as a normal part of aging. Some individuals were known to healthcare workers because of their disability and were visited regularly to check on their well-being and provide information about services. People with children, spouses and other close social connections got information and advice about eye health that was not available to individuals who were socially isolated due to mobility issues or disability-related stigma.

Conclusions: Older people with disabilities in Karamoja face a range of disability-specific challenges in their abilities to perceive, seek, reach and engage with health care. This study adds useful context to the population-based survey conducted in Karamoja in 2023 and demonstrates how the positive deviance approach can be helpful in identifying strategies to improve access where little or no evidence currently exists.